Healthcare Provider Details

I. General information

NPI: 1457856445
Provider Name (Legal Business Name): STEPHANIE YARNELL OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/29/2018
Last Update Date: 07/23/2025
Certification Date: 07/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

910 EASTLAKE PKWY
CHULA VISTA CA
91914-3558
US

IV. Provider business mailing address

910 EASTLAKE PKWY
CHULA VISTA CA
91914-3558
US

V. Phone/Fax

Practice location:
  • Phone: 619-210-1169
  • Fax:
Mailing address:
  • Phone: 619-210-1169
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number33936TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: